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In addition, the available quantities and the interval between prescribing and receiving treatment suggest that these transactions will likely be used by people storing drugs for future self-diagnosis and treatment, or for sale. Self-administration of antibiotics occurs in all countries, but it is particularly problematic where the use of antimicrobials without a prescription is encouraged by the lack of laws restricting antibiotic sales or a failure to enforce the laws. First, this study provides a sample of websites and providers, and thus may not be indicative of all suppliers selling over-the-counter antibiotics. To examine the types of Web sites and vendors dispensing antibiotics on the Internet, we conducted a search using 2 major search engines (Google and Yahoo) and the key words "purchase antibiotics without prescription" and "online (English only). Our final list of URLs included 184 links to single vendors of antibiotics. If patients who are now denied antibiotics through their physician can access over-the-counter medications, the overall level of antibiotic use in the general population can actually increase and thus have a significant effect on rates of resistance to microbial degradation. As websites appear and disappear at a relative frequency, searches and classifications were performed during the first week of September 2008. This decrease was interpreted as evidence that the full use of antibiotics was also reduced. Antibiotics serve a useful therapeutic purpose in treating and controlling the effects of infectious agents. Second, there was a considerable repetition in the Web sites, which made an accurate determination of unique vendors from the 184 different sites difficult, an effort that may have let to some error. Unfortunately, this strategy of focusing on prescribing practices does not address the behavior of self-medication with antibiotics. There are several limitations to this study. Antibiotic resistance is a common problem, however, and has been described with numerous infectious agents and in varying contexts. Specifically, we classified a single course of azithromycin as 6 pills, 250 mg each. Other providers are trying to upset this law by providing online diagnoses and prescriptions based on medical records without a physical examination and without a long relationship between the patient and the doctor, a practice that is not considered an adequate standard of care.

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